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General NPI Number Information
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NPI Number | 1235316597
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Entity Type | Organization
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Legal Business Name | THOMAS M DOMANICK DPM
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 11/07/2012
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Provider Practice Location Address
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Address Line | 1825 BARNUM AVE
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City | STRATFORD
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State | CT
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Zip | 06614-5333
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Country | US
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Telephone | 203-377-1777
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Fax | 203-378-8348
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Provider Business Mailing Address
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Address Line | 1825 BARNUM AVE SUITE 302
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City | STRATFORD
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State | CT
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Zip | 06614-5333
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Country | US
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Telephone | 203-377-1777
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Fax | 203-378-8348
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS M DOMANICK
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Credential | D,P.M.
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Telephone | 203-377-1777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | POO289
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | POO289
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License Number State | CT
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